4Psychological Interventions Research Centre, University College London

p.fonagy{at}ucl.ac.uk

Peter Fonagy and Alessandra Lemma say that the psychoanalytical approach can provide a useful and unique contribution to modern healthcare, but Paul Salkovskis and Lewis Wolpert argue that it may have no place there at all (doi:10.1136/bmj.e1188)

Psychoanalysis is under greater attack than ever before. An unprecedented decommissioning of psychoanalytic services has taken place across the United Kingdom’s National Health Service (for example, Forest House NHS Psychotherapy Clinic), justified by cost savings. What are the reasons for this attack and what can be said in psychoanalysis’s defence?

It has been claimed, perhaps fairly, that psychoanalysis and psychodynamic psychotherapies have failed to promote a culture of systematic evaluation and that the outcomes are difficult to measure and demonstrate. Relative to the number of studies on the effectiveness of cognitive behavioural therapy, few adequate studies are available of psychodynamic therapy outcomes. A growing body of studies, however, report that psychodynamic therapy is effective in the treatment of both mild and complex mental health problems. For example, a meta-analysis found substantial effect sizes in randomised controlled trials of long term psychodynamic psychotherapy, larger than those …